Despite this unparalleled efficacy for depression, ECT carries a risk of memory difficulties for a majority of patients who undergo this treatment. Patients often report being distressed and embarrassed by memory lapses about popular world events, family milestones such as their child's high school graduation, or trouble remembering and recalling new information such as ECT follow-up care instructions. Patients report that these memory impairments adversely impact their quality of life and their willingness to consent to receive needed treatment to complete their ECT course and maintain symptom remission. While variations in ECT technique have reduced this risk, they have not eliminated it. To date, no intervention to effectively mitigate ECT treatment-induced memory deficits has been developed. We propose to study a novel memory training program called Memory Training for ECT (Mem-ECT) that may help mitigate memory problems associated with ECT. This is a treatment-masked randomized controlled study with 60 depressed inpatients scheduled to undergo ECT. Participants will be randomized to either Mem-ECT, an active control group that provides general mental stimulation (puzzles) in a similar format as the memory training, or treatment as usual. We will determine if Mem-ECT is better at improving memory ability immediately following ECT and 2 months later. We will also study the integrity of biological memory mechanisms possibly impacted by the memory training, and in an exploratory manner, examine treatment factors such as medications and depression severity as potential mediators of improvement in cognition and quality of life. Our ultimate goal is to develop a safe and effective behavioral strategy to minimize the adverse memory side effects of ECT so that ECT is a more easily tolerated treatment. PUBLIC HEALTH RELEVANCE: People who undergo electroconvulsive therapy are at great risk for memory problems related to the seizure that occurs during the treatment. This study looks to see if applying a memory exercise program can minimize the adverse memory side effects of electroconvulsive therapy.